Holiday Satisfaction…with the Post Office!

December 20, 2012

I recently had a very pleasing experience with the U.S. Post Office. Why does that matter? Well, it’s the Post Office; it’s not exactly known for customer service.

We’re deep into the holiday season, and, this year, I’ve finished all of my shopping and mailing. See, I’m an habitual shopping and mailing procrastinator. My friends and family have put up with receiving presents late and getting them straight out of Amazon or other boxes, sans wrapping paper.

On top of that, I’ve put myself through a significant amount of last minute, next-day, expensive shipping. Ouch. Unfortunately, I learn the hard way, slowly.

This year, I was made aware of USPS scheduled pick-ups. I know a lot of people probably know about this and use it already. But it was a breath of fresh for me.

I set-up, paid for, and printed the mailing labels online. I scheduled a pick-up. I boxed everything up. I put it all on the porch when I left for work in the morning. When I came home, all the boxes were gone and I could verify their status online. It was much easier than going to the Post Office and much cheaper than FedEx or UPS.

It was almost perfect. The wrinkle came with a package UPS shipped to me. The UPS package was delivered before the mail pick-up. The mail carrier inadvertently picked up the UPS package along with everything else. At least that’s what I hoped. Otherwise, there would’ve been an even bigger SNAFU.

I was on the phone with USPS by 8:30 the next morning. After a couple of quick phone calls, I was on the phone with the person who picked up the UPS package. He was very pleasant, he recognized the issue right away, and told me it was back out for delivery. I felt back at-ease. I got home after work and the package was there at my front door.

Satisfied.


A Day in the Internet

March 14, 2012

This is pretty cool:

A Day in the Internet
Created by: MBAOnline.com

From http://www.mbaonline.com/a-day-in-the-internet/


Musings on Life

August 17, 2011

I haven’t written for a few months, not because I haven’t had things on my mind, but because there’s been a lot going on. Certainly, there has been a lot to talk about: revolutions in the Middle East, the U.S. debt debacle, the riots in England, the cast of Republican presidential contenders, along with stories of unsung heroes working to improve our government, cities, and lives.

But, I live in Colorado, and the summer is a distracting time of year, but only slightly more distracting than the winter. Mountain biking, hiking, rock climbing, camping, nightlife, baseball games, etc., etc., etc. all make every weekend here a small adventure. While I was last hiking in the mountains, I reflected on how fortunate I am to live in this state and enjoy its beauty.

Colorado is marvelous. From the mountains to the people, every day provides new excitement.

A series of not thoroughly planned actions brought me to Denver, landed me a job that has evolved several times and that I continue to enjoy, and connected me with countless inspiring people. All I had to do was take a few small chances and show up along the way.

All of my experiences continue to remind me of my inherent, moral responsibility to make similar opportunities possible for others. What does that mean? How?

In terms of character, first, be willing. Second, be open-minded. Accept possibilities and opportunities. Third, be honest. Follow through. Don’t promise what you can’t deliver. Build integrity.

Listen and lead by example. None of us know as much as we think we know, and actions always speak louder than words.

Most importantly, take action. Do what needs to be done. Do what you love to do. Soak up this life and give all that you can back.

With that, I’ll close with my favorite quote: “This is the true joy in life- that being used for a purpose recognized by yourself as a mighty one. That being a force of nature, instead of a feverish, selfish little clos of ailments and grievances complaining that the world will not devote itself to making you happy. I am of the opinion that my life belongs to the whole community and as long as I live it is my privilege to do for it whatever I can. I want to be thoroughly used up when I die. For the harder I work the more I live. I rejoice in life for its own sake. Life is no brief candle to me. It’s a sort of splendid torch which I’ve got to hold up for the moment and I want to make it burn as brightly as possible before handing it on to future generations.” (George Bernard Shaw)


There Has to be a Better Way

February 6, 2011

While sitting at almost a dead stop on I-70 for 40 minutes on the way to Vail this morning I began fantasizing about faster ways to get to the mountains.

Several ideas have come to mind in the past:
High-speed rail
An extra lane
A zipper lane (that one may actually happen)
A high-speed chairlift from Red Rocks to Eagle
A tunnel

Most of which are not financially feasible.

A personal helicopter would be ideal, but, again, not financially feasible.

But, that led me to the solution.

The military could fly Black Hawk helicopter shuttle flights to the top of ski resorts.  Vail could contract with the military and include the shuttle as an extra season pass perk.

Benefits:
Less traffic
Faster travel
Military pilot training
Military fundraising
Being awesome

Cons:
None come to mind

We skiers need a solution; put your thinking caps on.

(Disclaimer:  This is not a serious blog post. I’m just a bit jaded about traffic.)


WikiLeaks and the Afghan War – Republished

August 8, 2010

The United States’ war efforts in Afghanistan have been carrying on for what is now approaching a decade (alright, approaching 9 years).  Little in that country has changed, Al Qaeda is still active, and Osama bin Laden has not been killed or captured.

To say the American people’s patience with the war in Afghanistan is waning would be an understatement.  Victory in this war is a very unclear concept.  Spreading our “democracy” to people who don’t really care about it is a questionable endeavor.

These sentiments aren’t just a sentiment of my imagination.  These sentiments even reside in some, at least one, member of the U.S. military.  On July 25, 2010, the website WikiLeaks released what it calls the “Afghan War Diary”.  The Afghan War Diary is, essentially, a voluminous set of reports from the U.S. military regarding its efforts and difficulties in Afghanistan.  WikiLeaks obtained the information from a member of the U.S. military.

Opponents of the way cheered.  Proponents of the war have stopped just short of calling the actions treason.  The Pentagon has demanded the information be taken down.

Some proponents of open government see this as an advance in people driven information sharing and an increase in the sunlight on government activities.   Some proponents of open government see this as a setback to the efforts to promote transparency.

Many questions about.  Why was the information shared?  Is the information classified?  Does the information put U.S. soldiers at risk?

I don’t have answers to these questions, but the founder of STRATFOR Global Intelligence has shared some rather enlightening commentary that I think is worth sharing.

The following report is republished with permission of STRATFOR, http://www.stratfor.com/.

WikiLeaks and the Afghan War

By George Friedman

On Sunday, The New York Times and two other newspapers published summaries
and excerpts of tens of thousands of documents leaked to a website known as WikiLeaks. The documents comprise a vast array of material concerning the war in Afghanistan.  They range from tactical reports from small unit operations to broader strategic analyses of politico-military relations between the United States and Pakistan. It appears to be an extraordinary collection.

Tactical intelligence on firefights is intermingled with reports on confrontations between senior U.S. and Pakistani officials in which lists of Pakistani operatives in Afghanistan are handed over to the Pakistanis.  Reports on the use of surface-to-air missiles by militants in Afghanistan are intermingled with reports on the activities of former Pakistani intelligence chief Lt. Gen. Hamid Gul, who reportedly continues to liaise with the Afghan Taliban in an informal capacity.

The WikiLeaks

At first glance, it is difficult to imagine a single database in which such a diverse range of intelligence was stored, or the existence of a single individual cleared to see such diverse intelligence stored across multiple databases and able to collect, collate and transmit the intelligence without detection. Intriguingly, all of what has been released so far has been not-so-sensitive material rated secret or below. The Times reports that Gul’s name appears all over the documents, yet very few documents have been released in the current batch, and it is very hard to imagine intelligence on Gul and his organization, the Inter-Services Intelligence (ISI) directorate, being classified as only secret. So, this was either low-grade material hyped by the media, or there is material reviewed by the selected newspapers but not yet made public. Still, what was released and what the Times discussed is consistent with what most thought was happening in Afghanistan.

The obvious comparison is to the Pentagon Papers, commissioned by the Defense Department to gather lessons from the Vietnam War and leaked by Daniel Ellsberg to the Times during the Nixon administration. Many people worked on the Pentagon Papers, each of whom was focused on part of it and few of whom would have had access to all of it.

Ellsberg did not give the Times the supporting documentation; he gave it the finished product. By contrast, in the WikiLeaks case, someone managed to access a lot of information that would seem to have been contained in many different places. If this was an unauthorized leak, then it had to have involved a massive failure in security. Certainly, the culprit should be known by now and his arrest should have been announced. And certainly, the gathering of such diverse material in one place accessible to one or even a few people who could move it without detection is odd.

Like the Pentagon Papers, the WikiLeaks (as I will call them) elicited a great deal of feigned surprise, not real surprise. Apart from the charge that the Johnson administration contrived the Gulf of Tonkin incident, much of what the Pentagon Papers contained was generally known. Most striking about the Pentagon Papers was not how much surprising material they contained, but how little. Certainly, they contradicted the official line on the war, but there were few, including supporters of the war, who were buying the official line anyway.

In the case of the WikiLeaks, what is revealed also is not far from what most people believed, although they provide enormous detail. Nor is it that far from what government and military officials are saying about the war. No one is saying the war is going well, though some say that given time it might go better.

The view of the Taliban as a capable fighting force is, of course, widespread. If they weren’t a capable fighting force, then the United States would not be having so much trouble defeating them. The WikiLeaks seem to contain two strategically significant claims, however. The first is that the Taliban is a more sophisticated fighting force than has been generally believed. An example is the claim that Taliban fighters have used man-portable air defense systems (MANPADS) against U.S. aircraft. This claim matters in a number of ways. First, it indicates that the Taliban are using technologies similar to those used against the Soviets. Second, it raises the question of where the Taliban are getting them – they certainly don’t manufacture  MANPADS themselves.

If they have obtained advanced technologies, this would have significance on the battlefield. For example, if reasonably modern MANPADS were to be deployed in numbers, the use of American airpower would either need to be further constrained or higher attrition rates accepted. Thus far, only first- and second-generation MANPADS without Infrared Counter-Countermeasures (which are more dangerous) appear to have been encountered, and not with decisive or prohibitive effectiveness. But in any event, this doesn’t change the fundamental character of the war.

Supply Lines and Sanctuaries

What it does raise is the question of supply lines and sanctuaries. The most important charge contained in the leaks is about Pakistan. The WikiLeaks contain documents that charge that the Pakistanis are providing both supplies and sanctuary to Taliban fighters while objecting to American forces entering Pakistan to clean out the sanctuaries and are unwilling or unable to carry out that operation by themselves (as they have continued to do in North Waziristan).

Just as important, the documents charge that the ISI has continued to maintain liaison and support for the Taliban in spite of claims by the Pakistani government that pro-Taliban officers had been cleaned out of the ISI years ago. The document charges that Gul, the director-general of the ISI from 1987 to 1989, still operates in Pakistan, informally serving the ISI and helping give the ISI plausible deniability.

Though startling, the charge that Islamabad is protecting and sustaining forces fighting and killing Americans is not a new one. When the United States halted operations in Afghanistan after the defeat of the Soviets in 1989, U.S. policy was to turn over operations in Afghanistan to Pakistan.  U.S. strategy was to use Islamist militants to fight the Soviets and to use Pakistani liaisons through the ISI to supply and coordinate with them. When the Soviets and Americans left Afghanistan, the ISI struggled to install a government composed of its allies until the Taliban took over Kabul in 1996. The ISI’s relationship with the Taliban – which in many ways are the heirs to the anti-Soviet mujahideen – is widely known. In my book, “America’s Secret War,” I discussed both this issue and the role of Gul. These documents claim that this relationship remains intact. Apart from Pakistani denials, U.S. officials and military officers frequently made this charge off the record, and on the record occasionally. The leaks on this score are interesting, but they will shock only those who didn’t pay attention or who want to be shocked.

Let’s step back and consider the conflict dispassionately. The United States forced the Taliban from power. It never defeated the Taliban nor did it make a serious effort to do so, as that would require massive resources the United States doesn’t have. Afghanistan is a secondary issue for the United States, especially since al Qaeda has established bases in a number of other countries, particularly Pakistan, making the occupation of Afghanistan irrelevant to fighting al Qaeda.

For Pakistan, however, Afghanistan is an area of fundamental strategic interest. The region’s main ethnic group, the Pashtun, stretch across the Afghan-Pakistani border. Moreover, were a hostile force present in Afghanistan, as one was during the Soviet occupation, Pakistan would face threats in the west as well as the challenge posed by India in the east. For Pakistan, an Afghanistan under Pakistani influence or at least a benign Afghanistan is a matter of overriding strategic importance.

WikiLeaks and the Afghan War

It is therefore irrational to expect the Pakistanis to halt collaboration with the force that they expect to be a major part of the government of Afghanistan when the United States leaves. The Pakistanis never expected the United States to maintain a presence in Afghanistan permanently. They understood that Afghanistan was a means toward an end, and not an end in itself. They understood this under George W. Bush. They understand it even more clearly under Barack Obama, who made withdrawal a policy goal.

Given that they don’t expect the Taliban to be defeated, and given that they are not interested in chaos in Afghanistan, it follows that they will maintain close relations with and support for the Taliban. Given that the United States is powerful and is Pakistan‘s only lever against India, the Pakistanis will not make this their public policy, however. The United States has thus created a situation in which the only rational policy for Pakistan is two-tiered, consisting of overt opposition to the Taliban and covert support for the Taliban.

This is duplicitous only if you close your eyes to the Pakistani reality, which the Americans never did. There was ample evidence, as the WikiLeaks show, of covert ISI ties to the Taliban. The Americans knew they couldn’t break those ties. They settled for what support Pakistan could give them while constantly pressing them harder and harder until genuine fears in Washington emerged that Pakistan could destabilize altogether. Since a stable Pakistan is more important to the United States than a victory in Afghanistan – which it wasn’t going to get anyway – the
United States released pressure and increased aid. If Pakistan collapsed, then India would be the sole regional power, not something the United States wants.

The WikiLeaks seem to show that like sausage-making, one should never look too closely at how wars are fought, particularly coalition warfare. Even the strongest alliances, such as that between the United States and the United Kingdom in World War II, are fraught with deceit and dissension. London was fighting to save its empire, an end Washington was hostile to; much intrigue ensued. The U.S.-Pakistani alliance is not nearly as trusting. The United States is fighting to deny al Qaeda a base in Afghanistan while Pakistan is fighting to secure its western frontier and its internal stability. These are very different ends that have very different levels of urgency.

The WikiLeaks portray a war in which the United States has a vastly insufficient force on the ground that is fighting a capable and dedicated enemy who isn’t going anywhere. The Taliban know that they win just by not being defeated, and they know that they won‘t be defeated. The Americans are leaving, meaning the Taliban need only wait and prepare.

The Pakistanis also know that the Americans are leaving and that the Taliban or a coalition including the Taliban will be in charge of Afghanistan when the Americans leave. They will make certain that they maintain good relations with the Taliban. They will deny that they are doing this because they want no impediments to a good relationship with the United States before or after it leaves Afghanistan. They need a patron to secure their interests against India. Since the United States wants neither an India outside a balance of power nor China taking the role of Pakistan’s patron, it follows that the risk the United States will bear grudges is small. And given that, the Pakistanis can live with Washington knowing that one Pakistani hand is helping the Americans while another helps the Taliban. Power, interest and reality define the relations between nations, and different factions inside nations frequently have different agendas and work against each other.

The WikiLeaks, from what we have seen so far, detail power, interest and reality as we have known it. They do not reveal a new reality. Much will be made about the shocking truth that has been shown, which, as mentioned above, shocks only those who wish to be shocked. The Afghan war is about an insufficient American and allied force fighting a capable enemy on its home ground and a Pakistan positioning itself for the inevitable outcome. The WikiLeaks contain all the details.

We are left with the mystery of who compiled all of these documents and who had access to them with enough time and facilities to transmit them to the outside world in a blatant and sustained breach of protocol. The image we have is of an unidentified individual or small group working to get a “shocking truth” out to the public, only the truth is not shocking – it is what was known all along in excruciating detail. Who would want to detail a truth that is already known, with access to all this documentation and the ability to transmit it unimpeded? Whoever it proves to have been has just made the most powerful case yet for withdrawal from Afghanistan sooner rather than later.

This following report is republished with permission of STRATFOR, http://www.stratfor.com/.


Mammography Guidelines

November 25, 2009

The following is a response from Dr. Jerome Schroeder, a radiologist with Exempla St. Joseph’s Hospital in Denver and a good friend, to the recent mammography screening guidelines.  Dr. Schroeder can be contacted at jschroeder@divrad.com.

Considering the controversy of the new guidelines and the potential impacts on women’s health, I wanted to share Dr. Schroeder’s insight with the hope of spreading awareness, knowledge, and support of efforts to promote well-being.

Screening Mammography Guidelines

In the week of November 16th, 2009, the United States Preventative Service Task Force (USPSTF) issued guidelines changing the widely accepted recommendations for screening mammography by eliminating the recommendation completely for women in their 40s and changing the recommendation for screening in women over the age of 50 to every other year.  Although the USPSTF is an ‘independent panel of private-sector experts in prevention and primary care,’ no breast screening experts were a part of the panel that devised these guideline changes.

Even though the USPSTF ‘…recognizes that the benefit of screening seems equivalent for women aged 40 to 49 years and 50 to 59 years…’ (their website), they have chosen to drop all recommendations for screening women in their 40s, mostly due to the number of women needed to be screened (1904 women in their 40s invited to be screened compared to 1339 women in their 50s and 337 women in their 60s) in order to save one life and their concerns over ‘psychological harms’ and ‘inconvenience due to false-positive screening results.’ 

The USPSTF also raises concerns about ‘over diagnosis’ and treating cancers that wouldn’t otherwise kill the patient.  They further state that ‘a large proportion of the benefit of screening mammography is maintained by biennial screening’ thereby justifying their recommendation for every-other-year screening in women over age 50.

These new guidelines are contradictory to the recommendations of the American Cancer Society, the American College of Radiology, the Susan G. Komen for the Cure Foundation, the American College of Obstetrics and Gynecology, the Society of Breast Imaging and the National Cancer Institute all of which recommend at least biennial mammography beginning at age 40, with most recommending annual mammography.

Breast cancer is the most common non-skin cancer in women with nearly 230,000 new cases of invasive or non-invasive cancer in American women annually, or one case diagnosed every 2-3 minutes.  It is second in cancer deaths to lung cancer, killing over 41,000 American women annually.  This is about the same number of deaths from annual motor vehicle accidents, with one death every 13 minutes on average.

Since the establishment of regular screening mammograms in the US in the mid 1980s, there has been a precipitous decrease in the death rate from breast cancer, dropping over 2% per year since 1990, after remaining completely unchanged for the previous 50 years.  Since the treatment of breast cancer has improved only minimally in that same time, the main reason for the drop in the death rate is screening mammography.

Part of the controversy over whom and when to screen with mammography stems from the various analyses of 9 ‘original’ Randomly Controlled Trials (RCTs), which established the utility of mammography screening, the newest of which was completed in the early 1980s with the oldest ones from the 1960s.  We are indebted to these ground-breaking studies as they were the first to firmly establish a death rate decrease among women invited to screening with mammography.  These studies showed a significant decrease in breast cancer death rate in the group invited to screening compared to the age-matched not-invited control group, with individual trials showing up to a 31% decrease. The RCTs naturally underestimate the benefit of screening on the individual level, since they estimate the “intention-to-treat” benefit (i.e. mortality among screen-detected cases plus cases among non-attendees and compare it with the mortality among control cases).  When evaluating “service screening” and adjusting for potential biases, one can see that the benefit for women regularly attending screening is a 43% decrease in risk of dying from breast cancer.

Dr. Daniel Kopans, professor of Radiology at Harvard and senior radiologist in the Breast Imaging Division at Massachusetts General Hospital points out that the USPSTF used computer models over direct data to reach their conclusions and ignored other models which contradicted their results and even ignored their own data proving a significant death benefit for women screened in their 40s.  He also reminds us that the National Cancer Institute issued guidelines similar to the USPSTF in 1993, reversing them (back to annual or biennial screening beginning at age 40) in 1997 when it became ‘clear that they had misinterpreted the data.’

Kopans also illustrates that, while the death rate overall has dropped by 2.3% per year in screening populations since 1990, the drop in death rate has averaged 3.3% per year in women in their forties.  Furthermore, nearly 41% of life years lost to breast cancer occur in women diagnosed in their forties, despite accounting for only 15% of breast cancer cases overall. 

Disturbingly, there have been claims that these new guidelines have been released during the Health Care Debate in order to offer a way to ‘decrease’ the costs of breast cancer screening.  Certainly, costs have to be weighed before recommending any screening test.  Arguably, in terms of lives saved per dollar spent, a better benefit would be to shift health care funds towards programs like immunizations, which have a much larger ‘bang for the buck.’  However, our society has determined that spending money to diagnose curable breast cancers is a worthwhile endeavor, considering the breadth and reach of this disease.  Furthermore, if the USPSTF used its own data and logic, they would stop recommending screening for all women under age 60 as it still takes over 1300 women in their 50s invited to be screened to save one life.  They seem to imply that it is worth spending the money to save a woman in her 50s but not to save a woman in her 40s, as both groups have a similar screening benefit.  Although no insurance company has, as yet, publicly changed its annual mammogram benefits, in states like Utah, the only state that does not require insurance companies to provide annual mammograms, these recommendations may have deadly results.

Since the inception of regular screening mammograms, the percentage of non-invasive cancer (DCIS) diagnosed has gone from a rarity to up to 40% of cancers diagnosed in some settings.  It is theoretical that a certain percentage of these cancers, and even some low-grade invasive cancers, will never pose a lethal threat to the woman diagnosed.  Currently, however, there is no reliable method of determining which of these cancers needs to be treated and which can be left alone, with no threat to the patient.  We are, however, beginning to understand the biology and genetics of individual breast cancers and this knowledge is already influencing our treatment of certain cancers, obviating the need for chemotherapy in cases which previously would have been treated with aggressive and often debilitating and toxic agents.  This is where I feel the debate about breast cancer should be heading.  Instead of forming recommendations that may have political, financial or even personal biases, we should be working harder to understand the biology and science of this disease in order to develop more intelligent screening and treatment methods.   This may mean performing breast MRI in addition to or instead of mammography in some patient populations.  Newer, faster MRI imaging protocols may soon bring the costs of performing an MRI and the time it takes to do an MRI down to the currently accepted time and costs of doing a mammogram. Knowing who is performing and interpreting mammograms and ensuring high quality outcomes is another way of maximizing the usefulness of screening mammography. 

Using ‘anxiety’ over callback imaging and/or biopsies and citing the ‘inconvenience’ of having to undergo additional tests to justify screening recommendation changes is demeaning to women and their ability to withstand periods of uncertainty.  In fact, many studies have indicated only minimal and fleeting anxiety in women having to undergo additional tests with most women stating that the anxiety was ‘worth it’ to be certain of a negative final result with virtually none stating that their experience would prevent them from returning for annual screening.  In my own practice, I’ve experienced nearly universal cooperation with recommended additional imaging and biopsies, with an overwhelming percentage of women grateful for the ‘thoroughness’ of their care and their relief of having a negative final result.

In the end, whether or not to have an annual screening mammogram is and should be the decision of the individual patient after she has weighed the risks and benefits and has applied it to her own personal situation.  The benefits of annual screening mammography for all women over 40 are clear and far outweigh the risks.  The Breast Care Center at Exempla St. Joseph Hospital continues to strongly recommend annual mammography for all average-risk women from age 40 on and more aggressive screening for women determined to be at higher-than-average risk.

STATEMENTS OF SUPPORT FOR ANNUAL MAMMOGRAPHY FROM AGE 40:

REFERENCES

THE RANDOMIZED CONTROLLED TRIALS OF SCREENING

Duffy SW, Tabar L, Smith RA.  The Mammographic Screening Trials:  Commentary on the Recent Work by Olsen and Gotzsche.   CA A Cancer J Clin.  2002;52:68-71.

Kopans DB.  The Most Recent Breast Cancer Screening Controversy About Whether mammographic Screening benefits Women at Any Age: Nonsense and Nonscience.  AJR 2003;180:21-26

SCREENING REDUCES DEATH RATE IN THE GENERAL POPULATION

Kopans DB.  Beyond Randomized, Controlled Trials:  Organized Mammographic Screening Substantially Reduces Breast Cancer Mortality.  Cancer 2002;94: 580-581.

Tabar L, Vitak B, Tony HH, Yen MF, Duffy SW, Smith RA.  Beyond randomized controlled trials: organized mammographic screening substantially reduces breast carcinoma mortality.  Cancer 2001;91:1724-31

Duffy SW, Tabar L, Chen H, Holmqvist M, Yen M, Abdsalah S, Epstein B, Frodis Ewa, Ljungberg E, Hedborg-Melander C, Sundbom A, Tholin M, Wiege M, Akerlund A, Wu H, Tung T, Chiu Y, Chiu Chen, Huang C, Smith RA, Rosen M, Stenbeck M, Holmberg L.  The Impact of Organized Mammography Service Screening on Breast Carcinoma Mortality in Seven Swedish Counties.  Cancer 2002;95:458-469.

Otto SJ , Fracheboud J, Looman CWN,  Broeders MJM, Boer R, Hendriks JNHCL, Verbeek ALM,  de Koning HJ, and the National Evaluation Team for Breast Cancer Screening*  Initiation of population-based mammography screening in Dutch municipalities and effect on breast-cancer mortality: a systematic review Lancet 2003;361:411-417.

Feig S.  Estimation of Currently Attainable Benefit from Mammographic Screening of Women Aged 40-49 Years.  Cancer 1995;75:2412-2419.

Swedish Organised Service Screening Evaluation Group. Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with extended data. Cancer Epidemiol Biomarkers Prev. 2006;15:45-51.

SCREENING WOMEN AGES 40-49

Kopans DB.  The Breast Cancer Screening Controversy and the National Institutes of Health Consensus Development Conference on Breast Cancer Screening for Women ages 40-49.  Radiology 1999;210:4-9.

Kopans DB, Halpern E, Hulka CA. Statistical Power in Breast Cancer Screening Trials and Mortality Reduction Among Women 40-49 with Particular Emphasis on The National Breast Screening Study of Canada.  Cancer 1994;74:1196-1203.

Shapiro S. Evidence on Screening for Breast Cancer from a Randomized Trial.  Cancer. 1977;39:2772-278

Hendrick RE. Smith RA, Rutledge JH, Smart CR.  Benefit of Screening Mammography in Women Ages 40-49:  A New Meta-analysis of Randomized Controlled Trials.  Monogr Natl Cancer Inst 1997;22:87-92.

Kopans DB, Moore RH, McCarthy KA, Hall DA, Hulka C, Whitman GJ, Slanetz PJ, Halpern EF.  Biasing the Interpretation of Mammography Screening Data By Age Grouping:  Nothing Changes Abruptly at Age 50.  The Breast Journal 1998;4:139-145

Kopans DB. Bias in the Medical Journals: A Commentary. Am. J. Roentgenol 2005; 185: 176 – 182.

Kopans DB. Informed decision making: age of 50 is arbitrary and has no demonstrated influence on breast cancer screening in women. Am J Roentgenology 2005;185:177-82

Kopans DB. The Canadian Screening Program: A Different Perspective. AJR 1990;155:748-749

Yaffe MJ.  Correction: Canada Study.  Letter to the Editor JNCI 1993;85:94

Tarone RE.  The Excess of Patients with Advanced Breast Cancers in Young Women Screened with Mammography in the Canadian National Breast Screening Study.  Cancer 1995;75:997-1003.

SCREENING INTERVAL

Michaelson JS, Halpern E, Kopans DB.  Breast Cancer: Computer Simulation Method for Estimating Optimal Intervals for Screening.  Radiology 1999;21:551-560.


Realizing Democracy through Technology

September 16, 2009

Government is often thought of as having closed doors, being insensitive, inflexible, unbending, secretive, and controlling.  In short, the public doesn’t think highly of government.  And, it’s not just because the public has high expectations.  The public should have high expectations of the government of the greatest nation in the world. 

Yet, government is simply made up of people.  Our government administrators and our elected officials are our friends, neighbors, and colleagues.  Sometimes, something transforms these people with good intentions within the halls of bureaucracy.  Maybe it’s the tradition of facing negative public opinion.  Maybe it’s the stress of trying to please everyone.  Maybe government really is made up of self-serving, power-hungry, deaf-to-the-public, bureaucrats.  I don’t think that’s the case. 

Not every person can attend public hearings, speeches, debates, and other government events.  Many government events are held between 8 AM and 5 PM, Monday through Friday, which immediately excludes many people with regular, full-time jobs.

Luckily, technology and some dedicated, honest, citizen-oriented administrators are charging towards opportunities for informing and collaborating with the public.

Online technology, notably social media, enhances and expands the opportunities people have to share their opinions and participate in government decision-making.

Colorado Senate President Brandon Shaffer, for example, is using an online survey to supplement his personal visits around Colorado to invite suggestions from people about how to improve life in the state.  He’s also reaching out to people via Twitter and Facebook.  His follower and fan counts aren’t extensive, but these online efforts have a lot of potential to complement in-person events.

The Colorado Secretary of State’s Office involved the public in an informal comment period regarding changes to administrative rules.  Subject-matter experts who participated in past collaborative efforts were directly invited, and the public-at-large was welcomed to participate in commenting on proposed rules as well as making direct changes to the proposed rules using a Google Group site.  Government agencies are required to conduct open public comment periods prior to holding hearings to pass administrative rules, but this informal effort brought the public into direct communication with employees in the Secretary of State’s Office and gave people the opportunity to write the rules that will affect their transactions with the office.

To support citizens’ sharing their opinions and experiences with health care, Colorado Governor Bill Ritter launched a website to help citizens send letters to the editors of newspapers.  The site allows people to enter a zip code and retrieve the contact information for nearby newspapers.  People can then write their message and send it directly to the editors.  There are even pre-written points that people can add to their own messages or use to help get their thoughts flowing.

The Colorado legislature has been broadcasting its sessions since January 2008 on the Colorado Channel and online streaming video.  Former Colorado Speaker of the House Andrew Romanoff helped pioneer this effort to share the actions of state lawmakers with people who can’t come down to the Capitol to watch.

Current Speaker of the House Terrance Carroll is successfully using Facebook to both share political updates and to foster personal relationships. 

These are just a few examples of Colorado public officials using social media to further connect with people.  Several federal government agencies are also conducting social media efforts to share data and more easily obtain citizen feedback.  The TSA blog is one of the most successful examples.

While there are many admirable citizen engagement efforts being undertaken, there are still some efforts that are coming up short.  For example, Gov. Ritter issued a press release seeking comments to rules regarding roadless lands, a controversial issue here in the West.  However, the press release did not provide any information about how to submit comments.  That makes for a seemingly empty request for citizen input.  To be fair, however, Gov. Ritter is making several other efforts to promote communication with citizens and transparency in state government, such as with the Transparency Online Project.

Government, however, encounters several obstacles to successfully undertaking collaborative efforts.  Resources for developing and monitoring communication tools are often limited and specifications in terms of service and other regulations sometimes prevent the use of free tools. 

“But,” as former EPA CIO Molly O’Neill said, “technology is the easy part – creating truly collaborative services is much harder and brings big changes. True government collaboration means being open and transparent with data, assumptions, debates, and decisions.”

On top of the physical constraints, people’s perspective of government sometimes prevents them from participating.  Through years of tightly-held decision-making, some citizens have become disillusioned and have come to anticipate a lack of recognition from government- along the lines of “your comments will be disregarded in the order they were received.”  People may be reluctant to participate because they think it’s a waste of their time.  Then, there’s the old-guard that’s standing behind the closed doors. 

Through consistent, sincere efforts government is overcoming these obstacles.  The public needs to see that their comments and suggestions are being seriously considered.  The doors of the old-guard can be broken down with the dedication of thoughtful employees.

Public officials and administrators and the public are responsible for using these opportunities to establish better policies and programs and to push our government to truly support life, liberty, and the pursuit of happiness.  Government needs to provide the tools that are available and share information.  People need to share their voices and expertise.  And, government needs to listen.

Thomas Jefferson said, “An informed democracy will act responsibly.”  About 200 years later we may be realizing that vision.


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